摘要
目的研究两种手术方式治疗腰椎间盘突出伴不稳术后出现邻近节段退变的情况。方法将115例L4~5椎间盘突出伴不稳行腰椎后路椎间融合术患者根据手术方式分为经椎间孔腰椎间融合术(TLIF)组(开放组,53例)和微创经椎间孔腰椎间融合术(MIS-TLIF)组(微创组,62例)。手术前后评测邻近椎间盘Pfirrmann评分及椎间隙高度变化,术后通过Seo评分系统评估椎间小关节受损情况,应用疼痛VAS评分及ODI评分评估临床疗效,评估术后邻近椎间盘的退变情况。结果患者均获得随访,时间6~48个月。VAS评分及ODI评分:术后3 d微创组明显低于开放组,差异有统计学意义(P<0.01);术后1年两组比较差异无统计学意义(P>0.05)。术后多裂肌横截面积减少的程度及多裂肌脂肪化程度微创组明显小于开放组,差异有统计学意义(P<0.01)。手术对腰椎椎间关节的损伤开放组明显高于微创组,差异有统计学意义(P<0.05)。邻近节段退变的发生与多裂肌功能减退及小关节突退变具有相关性(P<0.01)。结论 MIS-TLIF治疗腰椎间盘突出伴不稳较开放TLIF可以更好地保护椎旁肌及小关节突的完整性,且术后近期邻近节段退变的发生率低。
Objective To compare the difference of adjacent segment degeneration（ASD） following minimally invasive or conventional open transforaminal lumbar interbody fusion.Methods According to the operative methods,115 cases with lumbar disc herniation at L4~5 level were divided into two groups,53 of which constituted the open group underwent transforaminal lumbar interbody fusion surgery（TLIF） and the others who made up the minimally invasive group underwent minimally invasive surgery transforaminal lumbar interbody fusion（MIS-TLIF）.Pfirrmann score and intervertebral space were compared before and after surgery to assess degenerative changes of adjacent discs.Seo score system was used to evaluate the damage of facet joint.The VAS and Oswestry disability index（ODI） were applied to assess the clinical effects.Results All patients got 6~48 months of follow-up.The VAS and ODI of MIS-TLIF group were significantly lower than the TLIF group at 3 days after operation,the differences had statistical significance （P〈0.01）.The VAS and ODI at 1 year after operation,there was no significant difference between two groups （P〉0.05）.Compared with the conventional open approach,less decrease of cross sectional area and less severe fatty degeneration of the multifidus muscle were observed in minimally invasive group,the difference was statistical significance（P〈0.01）.Compared to minimally invasive group,the facet joint injury of open group caused by the surgery was more serious.The difference was statistical significance（P〈0.05）.The study suggested a correlation between ASD and the degeneration of multifidus muscle and facet joint（P〈0.01）.Conclusions Compared with the conventional open approach,the MIS-TLIF can give the multifidus muscle and facet joint much more production in the treatment of lumbar disk herniation combining with instability of lumbar spine,and effectively reduce the incidence rate of ASD.
出处
《临床骨科杂志》
2017年第3期257-261,共5页
Journal of Clinical Orthopaedics
关键词
微创
经椎间孔腰椎融合术
邻近节段退变
对比研究
minimally invasive
transforaminal lumbar interbody fusion
adjacent segment degeneration
comparative study
